Shomeshekar Jakkula
Secunderbad
Summary
Seeking a challenging and rewarding opportunity to utilize and expand skills. Eager to contribute value and continue personal development in a dynamic environment. Excited about further enhancing capabilities and making a meaningful impact. Ready to take on new challenges and grow professionally.
Overview
14
14
years of professional experience
Work History
Associate Business Analyst - Current Role
OPTUM
08.2021 - Current
- Conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending and presenting information for operational, business and technology planning.
- Support short and long term strategic business activities - by developing, enhancing and maintaining operational information and models.
- Also develop and implement effective technology solutions through research and analysis of data and business processes.
- Demonstrate and apply understanding of UnitedHealth Group's business (e.g., specific business capabilities, functions, processes and business cycles).
- Developing project work plans.
- Demonstrate and apply understanding of health care industry trends and their drivers.
- Demonstrate understanding of the difference between business requirements and technical solutions.
- Act as bridge between business and technology.
- Maintain awareness of best practices/approaches related to the business analysis discipline (e.g., Business Analysis Body of Knowledge).
- Define and update the project schedule to track/measure progress of the requirements-gathering process (e.g., status, milestones, tasks, and deliverables).
- Working with users to define existing or new processes and recommend solutions and improvements.
- Conducting analysis of alternatives, recommendations, and data mapping.
- Create end user training material and operational documentation.
- Documenting workflow processes.
- Proficient in performing data analysis, querying databases, and utilizing SQL query tools.
- Creating end user training material and operational documentation.
- End to End Project Management.
- Requirement Prioritization & Estimation Techniques.
- Customer Experience & Stakeholder Management.
- Robotics process automation Tools.
- Overall knowledge and experience of US healthcare.
- Power BI & Tableau Tools (Using for Data Visualization).
Subject Matter Expert for Appeals & Grievances
OPTUM
08.2018 - 07.2021
- Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements.
- Entered claims data into system.
- Resolved problems resulting from claim settlement.
- Performed audit of randomly selected claims to ensure quality processing.
- Researches claim overpayments and requests funds.
- Followed adjudication policies and procedures to make sure proper payment of claims.
- Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims.
- Logged telephone calls in system and followed up on issue.
- Team Player, Self-Motivating attitude, Ability to facilitate diverse groups of people, Provide feedback to the instructional design team, Provide feedback to management on individual and group training results, Provide feedback on regular basis, Responsible for tracking assessment scores, Flexible to travel depending on business requirement to Manage the Team.
- Played Roles and Responsibilities of Appeal provider CSP SME for MD, MI, WA, WI, MS, NE total 6 states. Like floor support, SME Q&A, Quality review sessions, PKT conducted for improvements of RA Knowledge gap, Training provided to team in different states if inventory is completed. Escalations handled within the time period and on time. Good Rap-up with Onshore team. SAM Errors Rebutted.
- Trained Triage Team on ICUE as well as WA Provider Appeals. Support provided to cosmos Provider Appeal team as well in clarifying the questions from SME as well as RA side. (FL CSP Provider Appeals)
- Accountability towards the process for customer and spared weekend time to complete the cases.
- Bravo! Diamond Recognition Recognition for Compassion.
- Qualifications of being honest and having strong moral principles.
- Two bright ideas submitted for Client letter generation to avoid date format and extra space errors. Ideas are approved by green belt team and are in process of feasibility check. If we implement these ideas we can reduce the client letter errors by 45% across Comos and CSP appeals team.
- Has a good rapport with team and onshore counterparts. Motivates team whenever required and supports them well on their daily activities. Never hesitate to build healthy relation which helps business improvement.
- Service Hero of 2020.
Customer Service Associate (CSA) and mentor
Serco
04.2011 - 04.2012
- Handling prepaid, postpaid, GPRS, CDMA, Retailer help desk in voice and VAS activation and de-activation Request in non-voice.
- Floor support.
- Giving new updates in tariff plans.
- Handling Sr.CSA calls.
- Quality check.
Education
Master of business Administration - HR
St Xavier 's Post Graduate College
01.2013
B.Sc - undefined
Vikas Degree College
01.2010
XIIth - Bi.Pc
Gowtham Junior College
01.2007
Xth - undefined
St Paul's High School
01.2005
Skills
- MS-Office
- DTP
- C & C
- Excellent communication skill
- Outstanding telephone etiquette
- Effective interpersonal skills
- Demonstrated computer skills
- Professional customer service
- Medical terminology
- CPT codes
- ICD-9 codes
- Overpayment audits
- Claims adjustment
- Recovery of money
- Flag quality issues
- Maintaining logs
- Dispute management
- Equipment maintenance
Personal Information
- Father's Name: J. Venkateshwarllu
- Date of Birth: 11/05/87
- Nationality: Indian
- Marital Status: Married
Special Capabilities
- Excellent communication skill
- Outstanding telephone etiquette
- Effective interpersonal skills to handle several inquiries in a diplomatic manner
- Demonstrated computer skills in MS Word, Excel, Email and Internet
- Ability to provide professional customer service in hectic situations
Hobbies and Interests
- Making Friends
- Listening to Music
Disclaimer
I hereby declare that the above mentioned information is genuine to my knowledge and I bear the responsibility for the correctness of the above mentioned particulars.
Timeline
Associate Business Analyst - Current Role
OPTUM
08.2021 - Current
Subject Matter Expert for Appeals & Grievances
OPTUM
08.2018 - 07.2021
Customer Service Associate (CSA) and mentor
Serco
04.2011 - 04.2012
B.Sc - undefined
Vikas Degree College
XIIth - Bi.Pc
Gowtham Junior College
Xth - undefined
St Paul's High School
Master of business Administration - HR
St Xavier 's Post Graduate College
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